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Scandinavian Journal of Surgery : SJS :... Sep 2018Routine prophylactic abdominal drains after laparoscopic appendectomy for perforated appendicitis in children are still controversial. Throughout the history of surgery,...
BACKGROUND
Routine prophylactic abdominal drains after laparoscopic appendectomy for perforated appendicitis in children are still controversial. Throughout the history of surgery, potential benefits of the abdominal drains have been described. However, in recent studies, no benefits were observed and serious complications have been reported.
METHODS
From January 2000 to December 2013, all charts of the pediatric patients who underwent laparoscopic appendectomy in our tertiary center were revised. The data from 1736 appendectomies were analyzed. We only included those patients with perforated appendicitis treated with early appendectomy (n = 192). Prophylactic drains were established according to the surgeon's preference. The sample was divided into two groups, those with drain (n = 117) and those without drain (n = 75). Demographics, operative findings, and postoperative outcomes were analyzed in both groups.
RESULTS
Of all patients, 121 were male and 71 were female with a mean age of 7.77 ± 3.4 years. There were not statistically significant differences between the groups in gender (p = 0.82) and mean age (p = 0.31). There were no statistically significant differences between the two groups in the rate of intra-abdominal abscess, wound infection, and bowel obstruction. However, the drainage group has been statistically associated with an increased requirement of antibiotic and analgesic medication, fasting time, operative time, and length of hospital stay.
CONCLUSION
The prophylactic use of abdominal drainage after laparoscopic appendectomy for perforated appendicitis in children does not prevent postoperative complications and may be associated with negative outcomes. Prospective randomized studies will be necessary to verify this question.
Topics: Adolescent; Appendectomy; Appendicitis; Child; Child, Preschool; Drainage; Female; Humans; Infant; Infant, Newborn; Laparoscopy; Male; Postoperative Complications
PubMed: 29628008
DOI: 10.1177/1457496918766696 -
International Journal of Surgery... Apr 2020Acute appendicitis is among the most common indications for emergency abdominal surgery. The risk of perforation might increase with a delay in treatment. Therefore,...
Short-term outcome after appendectomy is related to preoperative delay but not to the time of day of the procedure: A nationwide retrospective cohort study of 9224 patients.
INTRODUCTION
Acute appendicitis is among the most common indications for emergency abdominal surgery. The risk of perforation might increase with a delay in treatment. Therefore, appendicitis is considered a surgical emergency, leading to appendectomies being frequently performed off-hours. However, numerous studies from other medical specialties have shown less favourable outcomes in patients admitted or treated off-hours than in those treated during regular working hours. The purpose of this study was to determine whether the time of day of the procedure and preoperative delay in appendectomy have significant impacts on morbidity and mortality rates.
METHODS
All appendectomies recorded in a prospective national quality measurement database (Arbeitsgemeinschaft für Qualitätssicherung in der Chirurgie (AQC)) between 2010 and 2017 were retrospectively analysed. The inclusion criteria were appendicitis (International Classification of Diseases diagnostic codes K35-K37), surgical treatment (appendectomy), and available information on the time of day the appendectomy was performed. We stratified patients into four groups according to the start of the operation-'MORNING' for surgeries started between 7:00 a.m. and 12:59 p.m., 'AFTERNOON' for surgeries started between 1:00 p.m. and 6:59 p.m., 'EVENING' for surgeries started between 7:00 p.m. and 11:59 p.m., and 'NIGHT' for surgeries started between midnight and 6:59 a.m. In a further analysis, we examined differences between patients who underwent surgery on the admission day and those who underwent surgery later. A total of 9224 patients with a mean age of 36 ± 19 years (54% men) were included and further analysed. The occurrence of any complication was the primary outcome, whereas in-hospital mortality was the secondary outcome. Variables were entered into bivariate and multivariate analyses.
RESULTS
Of the appendectomies, 38% were performed during the afternoon, 31% in the evening, 18% in the morning, and 13% at night-time. Patients who underwent surgery at night had slightly lower American Society of Anesthesiologists scores, were more often managed as emergency cases (98% of the cases), had fewer comorbidities, and were more often covered by statutory instead of private health insurance than the other patients. Junior attending and resident surgeons performed 88% of all night-time operations. The average duration of surgery was not significantly longer in the night-time group than in the day-time groups. The overall complication rate was 4.7%, ranging from 3.5% in the 'NIGHT' group to 5.0% in the 'AFTERNOON' group. However, the differences between the groups were not significant. The in-hospital mortality rate was 0.12% (n = 11), ranging from 0.082% (n = 1) in the 'NIGHT' group to 0.17% (n = 5) in the 'EVENING' group. The timing of appendectomy was not associated with mortality. However, the rates of complications, in-hospital mortality, and conversion were all significantly higher in patients with a preoperative delay of >24 h.
CONCLUSIONS
The time of day of performing an appendectomy does not seem have any significant effect on complication and mortality rates. However, a longer length of preoperative stay significantly increases the risk of complications and mortality. Night-time operations should be preferred over next-day surgery considering the equal perioperative risks observed in this study.
Topics: Acute Disease; Adolescent; Adult; Ambulatory Surgical Procedures; Appendectomy; Appendicitis; Comorbidity; Databases, Factual; Emergencies; Emergency Service, Hospital; Female; Hospital Mortality; Humans; Male; Middle Aged; Multivariate Analysis; Postoperative Complications; Prospective Studies; Retrospective Studies; Time Factors; Time-to-Treatment; Treatment Outcome; Young Adult
PubMed: 32068181
DOI: 10.1016/j.ijsu.2020.02.001 -
Endoscopy May 1987Occasionally the surgeon has to venture into exploratory laparotomy, in order to confirm his assessment and also to treat accordingly. However, laparoscopy has become a...
Occasionally the surgeon has to venture into exploratory laparotomy, in order to confirm his assessment and also to treat accordingly. However, laparoscopy has become a means of minimising such situations for the surgeon. Against this background few surgeons have of late, been using the laparoscope for confirming or discounting the particular pathology before proceeding to laparotomy. The laparoscopic procedure needs adequate knowledge, experience and precision in handling the instruments. The recent extensive upsurge in female sterilization via the laparoscope in India has made it possible to develop techniques which are new and different from the ones practiced in developed countries. Compelling occasions on the author leading to successful closure of the trochar perforation of the colon on the spot with the help of a band applicator alone has led to the concept of appendicectomy in practice; More so with the author's modified band applicator. This procedure can readily be mastered by the endoscopic surgeon.
Topics: Adolescent; Adult; Aged; Appendectomy; Child; Female; Humans; Laparoscopes; Male; Middle Aged
PubMed: 2956086
DOI: 10.1055/s-2007-1018257 -
La Pediatria Medica E Chirurgica :... Dec 2016Transumbilical laparoscopic assisted appendectomy combines laparoscopic single port dissection with open appendectomy after exteriorization of the appendix through the... (Comparative Study)
Comparative Study
Transumbilical laparoscopic assisted appendectomy combines laparoscopic single port dissection with open appendectomy after exteriorization of the appendix through the port site. Compared to the conventional three-port approach, this technique provides an alternative with excellent cosmetic outcome. We developed a safe and effective technique to perform an intracorporeal single port appendectomy, using the same laparoscope employed in the extracorporeal procedure. Retrospective review of 71 consecutively performed intracorporeal single port appendectomies and 30 conventional three-port appendectomies in children 6 to 17 years of age. A straight 10-mm Storz telescope with inbuilt 6 mm working channel is used to dissect the appendix, combined with one port-less 2.3 mm percutaneous grasper. Polymer WECK® hem-o-lock® clips are applied to seal the base of the appendix and the appendiceal vessels. No intraoperative complications were reported with the hybrid intracorporeal single port appendectomy or three-port appendectomy. There were two post-operative complications in the group treated with the single port hybrid technique: one intra-abdominal abscess and one surgical site infection. Groups did not differ in age, weight, and types of appendicitis. Operative times were shorter for the hybrid technique (70 vs 79 minutes) but did not differ significantly (P=0.19). This modified technique to a previously described single port extracorporeal appendectomy is easy to master and implement. It provides exposure similar to a three-port laparoscopic appendectomy, while maintaining virtually scarless results and potentially reduces the risk for surgical site infections compared to the extracorporeal technique.
Topics: Adolescent; Appendectomy; Appendicitis; Child; Female; Humans; Laparoscopy; Male; Operative Time; Postoperative Complications; Retrospective Studies; Umbilicus
PubMed: 28009138
DOI: 10.4081/pmc.2016.133 -
Indian Pediatrics Apr 2019To compare the outcomes of treatment in children with acute appendicitis between laparoscopic and open surgical approaches. (Comparative Study)
Comparative Study
OBJECTIVE
To compare the outcomes of treatment in children with acute appendicitis between laparoscopic and open surgical approaches.
DESIGN
Retrospective study.
SETTING
Division of Pediatric Surgery at a tertiary-care hospital in Croatia between January 2012 to December 2016.
PATIENTS
834 children [median (IQR) age 13 (11,15)] who underwent appendectomy; 301 in the laparoscopic group and 533 in the open group.
MAIN OUTCOME MEASURES
Postoperative complications, duration of hospitalization, re-operation, and the quantity of analgesics used.
RESULTS
The median length of hospital stay was 3 days in laparoscopic group compared to 6 days in open group (P<0.001). The amount of analgesics used was lower in patients with laparoscopic appendectomy compared to patients who underwent open procedure (P=0.042). Significantly higher number of wound infections was recorded in the open group (n=21; 3.9%) compared to laparoscopic group (n=3; 1%) (P=0.014). The frequency of re-operation in both groups was equal (1.3%). The median duration of surgery was shorter in the group of patients with laparoscopic appendectomy compared to the open approach (30 vs. 45 min; P<0.001). In five-year period, the proportion of laparoscopic appendectomies increased by 21.5%.
CONCLUSIONS
Laparoscopic appendectomy was safe and effective in children. Advantages of laparoscopic approach were shorter hospital stay, lower number of wound infections and lower usage of analgesics.
Topics: Adolescent; Appendectomy; Appendicitis; Child; Female; Humans; Length of Stay; Male; Postoperative Complications; Retrospective Studies; Treatment Outcome
PubMed: 31064898
DOI: No ID Found -
World Journal of Surgery Jun 2018To determine whether minimally invasive surgery (MIS) training improves outcomes in laparoscopic appendectomy, a procedure that is commonly performed in general surgery...
BACKGROUND
To determine whether minimally invasive surgery (MIS) training improves outcomes in laparoscopic appendectomy, a procedure that is commonly performed in general surgery training.
METHODS
Retrospective review was conducted of all patients undergoing laparoscopic appendectomy for suspected acute appendicitis between 2014 and 2015 at a single-center, tertiary-care academic institution. Patients operated on by MIS-trained surgeons (MIS group) were compared to those operated on by general surgeons (GS group). Single-incision and multiport laparoscopic appendectomies were included; open approach, known malignancy, and interval appendectomies were excluded.
RESULTS
A total of 507 patients were included in the study: 181 patients in the MIS group and 326 in the GS group. There were no differences in patient demographics or medical comorbidities between groups and most patients were ASA class 1 or 2. Patients operated on by MIS-trained surgeons had significantly shorter operative time (43 min, IQR 32-60 vs. 58 min, IQR 44-81; p < 0.001) and fewer intra-operative adverse events (0/181 vs. 8/326, 2.5%; p = 0.03). There was no difference in number of postoperative adverse events between groups (6/181, 3.3% vs. 21/326, 6.4%; p = 0.13). In the MIS group, subgroup analysis of single-incision versus multiport appendectomy showed no differences in intra-operative or postoperative adverse events. On multivariable linear regression, lack of MIS training and traditional multiport approach had the greatest effects on prolonging operative time (11.2 and 12.8 min, respectively; p = 0.001).
CONCLUSIONS
MIS fellowship improves operative metrics and patient outcomes even in basic laparoscopy.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Appendectomy; Appendicitis; Clinical Competence; Fellowships and Scholarships; Female; Humans; Laparoscopy; Male; Middle Aged; Minimally Invasive Surgical Procedures; Retrospective Studies; Treatment Outcome; Young Adult
PubMed: 29143092
DOI: 10.1007/s00268-017-4374-z -
Journal of the American College of... Jul 2007Laparoscopic appendectomy has been widely practiced for uncomplicated appendicitis; various reports demonstrated its merits in assisting diagnosis, reducing...
BACKGROUND
Laparoscopic appendectomy has been widely practiced for uncomplicated appendicitis; various reports demonstrated its merits in assisting diagnosis, reducing postoperative pain, analgesic requirement, and incidence of wound infection. The role of laparoscopy in management of complicated appendicitis, ie, gangrenous, perforated appendicitis and appendiceal abscess, remains undefined. Currently, the choice of operative approach is mostly at the surgeons' discretion. A retrospective study was conducted in our institution to review the feasibility, safety, and efficacy of laparoscopic appendectomy for patients with complicated appendicitis.
STUDY DESIGN
From January 1999 to January 2004, records of patients older than 14 years of age with diagnosis of appendicitis were retrieved from computer database for analysis. All patients underwent diagnostic laparoscopy to confirm diagnosis of complicated appendicitis, and patients subsequently underwent either laparoscopic or open appendectomies. Patients' demographics data and perioperative outcomes from the two groups were compared.
RESULTS
During the study period, 1,133 patients with acute appendicitis underwent operations in our institution. Two hundred forty-four patients (21.5%) with complicated appendicitis were identified by laparoscopy, of which 175 underwent laparoscopic appendectomy (LA) and 69 had open appendectomy (OA). Both groups of patients were comparable in demographics. Mean operative time was 55 minutes for LA group and 70 minutes for the OA group (p<0.001). Mean hospital stay was 5 days and 6 days for LA and OA group respectively (p<0.001). There was one conversion patient (0.6%) in the LA group who suffered from wound infection, and there were seven (10%) wound infections in the OA group (p=0.001). There were 10 cases (5.7%) of intraabdominal collection in the LA group and 3 (4.3%) in the OA group (p=0.473). There was no mortality in the current series.
CONCLUSIONS
Laparoscopic appendectomy for complicated appendicitis is feasible and safe. It is associated with a significantly shorter operative time, lower incidence of wound infection, and reduced length of hospital stay when compared with patients who had open appendectomy.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Appendectomy; Appendicitis; Databases, Factual; Feasibility Studies; Female; Humans; Laparoscopy; Length of Stay; Male; Middle Aged; Retrospective Studies; Treatment Outcome
PubMed: 17617333
DOI: 10.1016/j.jamcollsurg.2007.03.017 -
The Journal of Surgical Research Mar 2012Appendectomy is one of the most commonly performed emergency operations in children. The diagnosis of appendicitis can be quite challenging, particularly in children. We... (Comparative Study)
Comparative Study
BACKGROUND
Appendectomy is one of the most commonly performed emergency operations in children. The diagnosis of appendicitis can be quite challenging, particularly in children. We set out to determine the accuracy of diagnosis of appendicitis by analyzing the trends in the negative appendectomy rate (NAR) using a national database.
MATERIALS AND METHODS
Analysis of the Kids Inpatient Database (KID) was performed for the years 2000, 2003, and 2006 on children with appendectomy, excluding incidental appendectomies. Children (<18 y) without appendicitis but who underwent appendectomies were classified as negative appendectomies (NA), and those with appendicitis as positive appendectomies (PA). Comparisons were made between those with PA versus NA by demographic characteristics. The subset of patients with NA was then further analyzed.
RESULTS
An estimated 250,783 appendectomies met the inclusion criteria. The NAR was 6.7%. Length of stay (LOS) was longer in NA versus PA (7 versus 3 d, P < 0.05). The NAR was increased in children under 5 y (21.1% versus 5.4% for among the 5-10 y versus 5.9% among the >10 y, P < 0.0001) and in females (9.3% versus 5.1%, P < 0.001). On multivariate analysis, increasing age was associated with lower odds of NA (OR = 0.92, P < 0.001). Females, rural hospitals, and Blacks were significantly more likely to experience NA.
CONCLUSIONS
Younger age, female gender, Black ethnicity and rural hospitals are independent predictors of NA. These factors can be incorporated into diagnostic algorithms to improve the accuracy of diagnosis of appendicitis in children.
Topics: Adolescent; Age Factors; Algorithms; Appendectomy; Appendicitis; Child; Child, Preschool; Databases, Factual; Female; Hospitals, Rural; Humans; Length of Stay; Male; Racial Groups; Regression Analysis; Retrospective Studies; Sex Factors; Survival Rate
PubMed: 21696768
DOI: 10.1016/j.jss.2011.04.046 -
Archives of Surgery (Chicago, Ill. :... Apr 2001The incidence of postoperative intra-abdominal abscess is higher after laparoscopic compared with open appendectomy for perforated appendicitis.
HYPOTHESIS
The incidence of postoperative intra-abdominal abscess is higher after laparoscopic compared with open appendectomy for perforated appendicitis.
METHODS
A historical cohort study of pediatric patients operated on for suspected appendicitis by open appendectomy or laparoscopic appendectomy compares the incidence of postoperative intra-abdominal abscess for each procedure.
SETTING
A tertiary care center.
PATIENTS
Five hundred thirty-eight pediatric patients were operated on for suspected appendicitis at our institution between 1974 and 1999. Of these, 453 were included in the study. Of the excluded patients, 9 had incomplete medical records, 69 had normal or interval appendectomies, and 7 had appendixes removed by methods other than laparoscopy or right lower quadrant incision.
INTERVENTIONS
Open appendectomy performed through a right lower quadrant incision or laparoscopic appendectomy performed through a 3-trocar approach by 1 of 3 pediatric surgeons at our institution.
MAIN OUTCOME MEASURE
The incidence of postoperative intra-abdominal abscess after laparoscopic vs open appendectomy.
RESULTS
In perforated appendicitis (170 patients), the incidence of postoperative abscess after laparoscopic appendectomy was 24% vs 4.2% after open appendectomy. The relative risk ratio of developing a postoperative abscess after perforated appendicitis was 5.6 (confidence interval, 2.1-16.0) after laparoscopic vs open appendectomy. The results remained significant when controlled for age, sex, intraoperative irrigation, and preoperative antibiotics. Postoperative abscess in all acute, gangrenous, and perforated appendicitis after laparoscopic appendectomy was 6.4% vs 3.0% after open appendectomy. This was not statistically significant.
CONCLUSION
There is a significant increase in the incidence of postoperative intra-abdominal abscess with perforated appendicitis after laparoscopic compared with open appendectomy in pediatric patients.
Topics: Abdominal Abscess; Appendectomy; Appendicitis; Child; Humans; Intestinal Perforation; Laparoscopy; Retrospective Studies; Surgical Wound Infection
PubMed: 11296116
DOI: 10.1001/archsurg.136.4.438 -
American Journal of Surgery May 2000Laparoscopic appendectomy is commonly performed and has been presumed to offer economic benefits similar to those of laparoscopic cholecystectomy. This study was done to... (Comparative Study)
Comparative Study
BACKGROUND
Laparoscopic appendectomy is commonly performed and has been presumed to offer economic benefits similar to those of laparoscopic cholecystectomy. This study was done to examine that premise.
METHODS
Two surgical groups contributed consecutively operated patients with a clinical diagnosis of appendicitis. One group did all appendectomies open and the other group did them laparoscopically. Hospital expenses were compared using a single billing formula. Hospital length of stay, time to return to work, and complications were analyzed.
RESULTS
Operating room times were longer for the laparoscopic group, median 80 minutes, versus median 50 minutes for the open group. Hospital length of stay and return to work were the same, median 1 day and median 10 days, respectively. Wound complications were less common in the laparoscopic group, 0 of 30, than in the open group, 3 of 18; however, there was 1 intra-abdominal abscess in the laparoscopic group. Median cost of the laparoscopic group was $2,915 versus $1,747 for the open group.
CONCLUSIONS
Laparoscopic appendectomy is more expensive than appendectomy but does not reduce hospital length of stay nor change the time to return to work; however, wound complications are less common.
Topics: Absenteeism; Acute Disease; Adolescent; Adult; Aged; Appendectomy; Appendicitis; Child; Cost-Benefit Analysis; Female; Hospital Charges; Hospital Costs; Humans; Laparoscopy; Length of Stay; Male; Middle Aged; Retrospective Studies; Technology Assessment, Biomedical; Time Factors; Wound Infection
PubMed: 10930483
DOI: 10.1016/s0002-9610(00)00373-1